Endometriosis, a modern syndrome.

The identification of endometriosis has been a subject of intense debate over the last decade. There is, however, no doubt that Thomas Cullen was the first to describe endometriosis and adenomyosis as one disease characterized by the presence of endometrium-like tissue outside the uterine cavity. With the introduction of laparoscopy in the early 1960s three different clinical presentations of endometriosis were distinguished: peritoneal, deep adenomyotic and cystic ovarian. As soon as synthetic steroids became available, pioneer clinicians started utilizing these in an attempt to replace radical surgery by a medical treatment. While medical therapy may resort in relief, in most cases the current approach consists of a combination of medical and surgical therapy. While the pathogenesis of endometriosis is still enigmatic and complex, there is increasing evidence that endometriosis is part of a uterine reproductive dysfunction syndrome. For prevention of complications, it is very important that diagnosis is made as early as possible in a woman's life.

Endometriosis infiltrante: Revisión de tema / Deep endometriosis: a review

La endometriosis infiltrante o profunda se define como la presencia de lesiones endometriales que infiltran el tejido más de 5mm, se ubican en el retroperitoneo en sitios diferentes a la endometriosis común y comprometen diferentes estructuras u órganos como intestino, uréter, vejiga, ligamentos útero sacros y región rectovaginal, pudiendo alterar la calidad de vida de la mujer. Los síntomas más frecuentes incluyen la dismenorrea, la dispareunia y la disquexia. Una aproximación al diagnóstico incluye la historia clínica con énfasis en los síntomas dolorosos de la endometriosis profunda, el examen físico con evaluación de la pelvis y las ayudas diagnósticas que dependen del sistema comprometido y que van desde la eco transvaginal, ecotransrectal y/o resonancia magnética, hasta el colon por enema con doble contraste y la urografía excretora o el urotac. La cirugía es la opción más efectiva para el tratamiento en el tiempo dependiendo del sitio de ubicación y el compromiso de los diferentes órganos; sin embargo, el tratamiento farmacológico es una conducta vigente y con indicaciones precisas que pudiera ser la opción principal o complementaria, a pesar de la recurrencias de los síntomas o de las lesiones. Dado que la endometriosis infiltrante o profunda es una enfermedad multisistémica, debe ser manejada por un equipo multidisciplinario.

This paper is a review of infiltrating or deep endometriosis and includes the definition, clinic, diagnostic tools and different options of medical and surgical treatment. Deep endometriosis is defined as the presence of endometrial injuries that infiltrate the tissue in more than 5mm. are located in the retro-peritoneum in different places than the common endometriosis which jeopardize different structures and organs such as: intestine, ureter. bladder, uterosacral ligaments and the rectovaginal area, being able to alter the woman's quality of life. The most frequent symptoms include dysmenorrhoea, dyspareunia and dysquexia. An approach to the diagnosis includes a good clinical history with emphasis in the painful symptoms. Physical examination with pelvis evaluation and the diagnostic tools that depend on the jeopardized system and includes transvaginal ultrasound, transrectal ultrasound and/or magnetic resonance, colon by enema with double contrast and the excretory urography or urotae. Surgery is the most effective option for the treatment at this time. Depending on the location and the involvement of the different organs; nevertheless, pharmacological treatment with precise indications is a valid conduct and could be the main or a complementary option, in spite of the recurrences of symptoms or injuries. Since the infiltrating or deep endometriosis is a multi-systemic disease, it must be handled by a multidisciplinary team.